模拟临床的猪腹壁切口疝模型建立研究

doi:10.3877/cma.j.issn.1674-392X.2024.02.008

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 168 -172. doi: 10.3877/cma.j.issn.1674-392X.2024.02.008

疝修补材料专栏

模拟临床的猪腹壁切口疝模型建立研究

仲洁¹, 逯景辉², 林振华³, 程文悦⁴, 代京⁴, 张剑⁴^,^†(

), 刘成虎³^,^†(

)

^1. 200093　上海理工大学健康科学与工程学院；200003　上海，海军军医大学第二附属医院（上海长征医院）肛肠外科
^2. 250012　济南，山东大学齐鲁医院普外科
^3. 250101　济南，山东省医疗器械和药品包装检验研究院
^4. 200003　上海，海军军医大学第二附属医院（上海长征医院）肛肠外科

收稿日期:2024-03-01 出版日期:2024-04-18
通信作者: 张剑, 刘成虎
基金资助:
国防科技卓越青年科学基金(2019-JCJQ-ZQ-002)

A study on the establishment of a pig model of abdominal wall incisional hernia for clinical simulation

Jie Zhong¹, Jinghui Lu², Zhenhua Lin³, Wenyue Cheng⁴, Jing Dai⁴, Jian Zhang⁴^,^†(), Chenghu Liu³^,^†()

^1. School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China; Department of Anorectal Surgery, the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai 200003, China
^2. Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
^3. Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan 250101, Shandong, China
^4. Department of Anorectal Surgery, the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai 200003, China

Received:2024-03-01 Published:2024-04-18
Corresponding author: Jian Zhang, Chenghu Liu

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

仲洁, 逯景辉, 林振华, 程文悦, 代京, 张剑, 刘成虎. 模拟临床的猪腹壁切口疝模型建立研究[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 168-172.

Jie Zhong, Jinghui Lu, Zhenhua Lin, Wenyue Cheng, Jing Dai, Jian Zhang, Chenghu Liu. A study on the establishment of a pig model of abdominal wall incisional hernia for clinical simulation[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(02): 168-172.

目的

探讨建立模拟临床的猪腹壁切口疝模型方法及其可行性。

方法

入组36只实验猪，采用开放手术切除腹白线并保留腹膜的方式建立猪腹壁切口疝模型，术后每周观察猪腹部隆起和猪的生长情况，确认腹壁切口疝形成时间。于造模术后3个月行腹腔镜联合开腹手术，测量腹壁腱膜缺损大小（缺损长径、短径、面积）、确诊切口疝形成的则行疝环单纯缝合修复。修复术后每周观察腹壁切口疝复发情况，验证腹壁切口疝模型能否模拟临床切口疝的病理生理。

结果

造模后，36只猪均活动良好，无死亡。所有猪造模后生长情况良好。36只猪在造模术后1个月左右均出现腹部隆起，触诊形成腹壁切口疝。均于造模术后3个月时行腹腔镜联合开腹手术下疝环单纯缝合修复术，所有猪在修复术后1个月左右（平均25 d）出现疝复发，腹壁疝造模均成功。其成模时的疝环长径、疝环短径、疝环面积大于造模时的腹壁缺损长径、缺损短径及缺损面积，差异均有统计学意义（P<0.05）。

结论

采用本文的造模方法可以建立有效而稳定、无自愈倾向能模拟临床切口疝病理生理的猪腹壁切口疝模型。

关键词: 腹壁切口疝, 模型，动物, 模拟临床

Objective

To investigate the method of establishing a porcine abdominal wall incisional hernia model that simulates the clinical situation and its feasibility.

Methods

A total of 36 experimental pigs were enrolled, and a porcine abdominal wall incisional hernia model was established by openly removing linea alba and preserving the peritoneum. The abdominal bulge and growth of the pigs was observed every week after the operation, and the formation time of abdominal wall incisional hernia was determined. Laparoscopic combined with open surgery was performed at 3 months after modeling, and the size of the abdominal wall aponeurosis defect was measured ( long diameter, short diameter and area of the defect ). In experimental pigs with incisional hernias, the hernia ring was repaired using simple suture. Recurrence of abdominal wall incisional hernia was observed weekly after repair. To verify whether the model of abdominal incisional hernia can simulate the pathophysiology of clinical incisional hernia.

Results

After modeling, all 36 pigs moved well and did not die. All the pigs grew well after modeling, and all 36 pigs developed abdominal bulges and abdominal wall incisional hernias on palpation about 1 month after modeling. The hernia ring was repaired with simple suture under laparoscopic combined with open surgery at 3 months after modeling, and all pigs showed hernia recurrence about 1 month after repair (average 25 d), and the abdominal wall hernia modeling was successful. The long diameter, the short diameter, and the area of the hernia ring at the time of modeling were greater than those of the abdominal wall defect, and the differences were statistically significant (P<0.05).

Conclusion

An effective and stable model of pig abdominal wall incisional hernia can be established by using the modeling method presented in this paper. It can simulate the pathophysiology of clinical incisional hernias without self-healing tendencies.

Key words: Abdominal wall incisional hernia, Model, animal, Clinical imitation

图1 实验猪成模检测时腹部包块与疝环观察注：1A造模术后3个月腹部包块；1B成模时疝环；1C腹腔镜检查发现疝环。

表1 实验猪造模时、成模时和复发时生长情况比较（n=36，

±s）

观察时间	体重(kg)	胸围(cm)
造模时	47.39±7.27	51.73±4.56
成模时	92.59±9.14	86.84±4.57
复发时	105.20±10.07	96.06±5.58

表1 实验猪造模时、成模时和复发时生长情况比较（n=36，

±s）

观察时间	体重(kg)	胸围(cm)
造模时	47.39±7.27	51.73±4.56
成模时	92.59±9.14	86.84±4.57
复发时	105.20±10.07	96.06±5.58

表2 实验猪造模时和成模时缺损测量数据比较（n=36，

±s）

观察时间	缺损长径(cm)
造模时	4.67±0.61	3.32±0.76	12.23±3.47
成模时	8.03±1.72	5.18±1.83	33.85±16.55
t值	11.03	5.63	7.67
P值	<0.001	<0.001	<0.001

表2 实验猪造模时和成模时缺损测量数据比较（n=36，

±s）

观察时间	缺损长径(cm)
造模时	4.67±0.61	3.32±0.76	12.23±3.47
成模时	8.03±1.72	5.18±1.83	33.85±16.55
t值	11.03	5.63	7.67
P值	<0.001	<0.001	<0.001

[1]	医疗器械临床前动物研究　第3部分:用于评价补片组织学反应与生物力学性能的动物腹壁切口疝模型: YY/T1754.3-2023[S]. 国家药品监督管理局, 2023.
[2]	陈双, 江志鹏. 再论腹壁的力学原理——各向异性的临床与思考[J]. 中国实用外科杂志, 2022, 42(2): 159-162.
[3]	BittnerR, Bingener-Casey J, Dietz U, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society[IEHS])-Part Ⅲ[J]. Surg Endosc, 2014, 28(2): 380- 404.
[4]	孙立, 陈杰, 申英末, 等. 生物补片在腹股沟疝治疗中应用[J]. 中国实用外科杂志, 2017, 37(11): 1223-1227.
[5]	Smart NJ, Marshall M, Daniels IR. Biological meshes: a review of their use in abdominal wall hernia repairs[J]. Surgeon, 2012, 10(3): 159-171.
[6]	Guerra O, Maclin MM. Non-crosslinked porcine-derived acellular dermal matrix for the management of complex ventral abdominal wall hernias: a report of 45 cases[J]. Hernia, 2014, 18(1): 71-79.
[7]	Pengelly S, Carlson GL, Berry JEA, et al. Regulation of Peritoneal Inflammatory Response to Implant Material Using an Ex Vivo Model System[J]. J Surg Res, 2020, 247: 202-210.
[8]	Saiding Q, Chen Y, Wang J, et al. Abdominal wall hernia repair: from prosthetic meshes to smart materials[J]. Mater Today Bio, 2023, 21: 100691.
[9]	Shi H, Wang R, Dong W, et al. Synthetic Versus Biological Mesh in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Recommendations from Evidence-Based Medicine[J]. World J Surg, 2023, 47(10): 2416-2424.
[10]	陈雨荣, 安星兰, 汪正铸, 等. 猪作为人类疾病模型的研究进展[J]. 中国比较医学杂志, 2020, 30(7): 110-119.
[11]	Muysoms FE, Antoniou SA, Bury K, et al. European Hernia Society guidelines on the closure of abdominal wall incisions[J]. Hernia, 2015, 19(1): 1-24.
[12]	Jairam AP, López-Cano M, Garcia-Alamino JM, et al. Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis[J]. BJS Open, 2020, 4(3): 357-368.
[13]	Holmdahl V, Strigård K, Gunnarsson U. Autologous full-thickness skin in the repair of complex ventral hernias: an innovative step into the future of complex hernia repair?[J]. Front Surg, 2023, 10: 1301702.
[14]	中华医学会外科学分会疝和腹壁外科学组. 腹壁切口疝诊疗指南(2018年版)[J]. 中华外科杂志, 2018, 56(7): 499-502.
[15]	Lunney JK, Van Goor A, Walker KE, et al. Importance of the pig as a human biomedical model[J]. Sci Transl Med, 2021, 13(621): eabd5758.
[16]	Chase NF, Carballo CJ, Faulkner JD, et al. Laparotomy Closure: A Review of Available Education Training Models[J]. Surg Technol Int, 2020, 28: 121-125.
[17]	Vogels RRM, Kaufmann R, van den Hil LCL, et al. Critical overview of all available animal models for abdominal wall hernia research[J]. Hernia, 2017, 21(5): 667-675.
[18]	Patiniott P, Stagg B, Karatassas A, et al. Developing a Hernia Mesh Tissue Integration Index Using a Porcine Model-A Pilot Study[J]. Front Surg, 2020, 26: 600195.
[19]	邓美海, 林楠, 胡昆鹏, 等. 猪切口疝模型的建立及使用生物型补片修补的研究[J]. 中华实验外科杂志, 2008, 25(10): 1260-1261.
[20]	Sahoo S, Baker AR, Haskins IN, et al. Development of a critical-sized ventral hernia model in the pig[J]. J Surg Res, 2017, 210: 115-123.
[21]	杨硕, 申英末, 钟杏霞, 等. 感染型猪腹壁切口疝模型的建立和聚丙烯复合脱细胞基质材料新型补片耐受感染能力的实验研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2014, 8(5): 7-10.
[22]	Han JJ. FDA Modernization Act 2. 0 allows for alternatives to animal testing[J]. Artif Organs, 2023, 47(3): 449-450.
[23]	Ninkovic M, Ninkovic M, Öfner D, et al. Reconstruction of Large Full-Thickness Abdominal Wall Defects Using a Free Functional Latissimus Dorsi Muscle[J]. Front Surg, 2022, 17: 853639.
[24]	Borrelli MR, Shen AH, Griffin M, et al. A Novel Xenograft Model Demonstrates Human Fibroblast Behavior During Skin Wound Repair and Fibrosis[J]. Adv Wound Care(New Rochelle), 2022, 11(9): 455-465.
[25]	Yang S, Chen J, Shen Y, et al. Establishment of a Rabbit Model of Giant Abdominal Wall Hernia[J]. Surg Innov, 2019, 26(3): 376-380.

[1]	李帝均, 王斌. 肩袖损伤修复的生物材料选择及动物模型评价[J]. 中华关节外科杂志(电子版), 2024, 18(01): 118-124.
[2]	施洪鑫, 唐志方, 郭民政, 浦路桥, 齐保闯, 任俊筱, 李川. 碘乙酸钠在鼠类骨关节炎造模的方法和作用探索[J]. 中华关节外科杂志(电子版), 2023, 17(04): 534-539.
[3]	杨晓龙, 张立智, 刘晓东. 非侵入性加压负载模型在膝骨关节炎研究中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(01): 86-92.
[4]	袁静, 杨超, 陈娟. 间充质干细胞对新生儿缺氧缺血性脑损伤的神经保护作用[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(04): 386-391.
[5]	岳聚安, 郭晓忠, 王冉东, 李兵, 孙强, 刘忘言, 陈蛟, 李迎楠. 激素性股骨头坏死动物模型国内外研究现状及进展[J]. 中华损伤与修复杂志(电子版), 2020, 15(02): 142-145.
[6]	章盖, 耿乐乐, 方勇. 缺血再灌注对小鼠胸部皮瓣的影响及机制研究[J]. 中华损伤与修复杂志(电子版), 2019, 14(06): 416-425.
[7]	张大伟, 袁晓鹏, 李海燕, 李宗晏, 梁浩, 黄镇辉, 蒋小峰, 薛平. 肝左、中叶胆管结扎联合二乙基亚硝胺构建胆管癌小鼠模型的研究[J]. 中华普通外科学文献(电子版), 2019, 13(06): 430-434.
[8]	郭艳, 张明, 牛河源, 孟兴凯. 胰十二指肠切除后消化道重建的动物模型选择[J]. 中华普外科手术学杂志(电子版), 2023, 17(01): 101-104.
[9]	蒋美玲, 张凯. 老年患者腹壁切口疝修补术后复发的危险因素探讨及风险列线图模型的建立[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(02): 191-195.
[10]	邵煜奇, 王敏娟. 腹腔镜下腹壁切口疝的治疗及并发症预防研究进展[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(03): 312-315.
[11]	田广健, 刘鹏, 杨佩, 赵鑫. 开放手术辅助腹腔镜与完全腹腔镜下修补术治疗腹壁切口疝的临床研究[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(05): 481-484.
[12]	何学元, 马建勋, 俞泽元. 腹壁切口疝并发肠梗阻的易感因素分析及防治措施[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(02): 160-163.
[13]	符常波, 汪群, 段传宜, 陆卫军. 腹腔镜联合开腹补片修补术对巨大切口疝及肠黏连紧密腹壁切口疝患者临床研究[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(01): 55-58.
[14]	吴卫东. 壹孔境现（单孔TES在腹壁切口疝中的应用）[J]. 中华腔镜外科杂志(电子版), 2020, 13(04): 0-0.
[15]	李涛, 沙地克·阿帕尔, 吴警, 张皓, 江多斯·帕依孜吾拉, 曾齐, 曾齐努尔扎提江·安维尔, 吐尔洪江·吐逊. 大鼠减体积自体肝移植模型的建立[J]. 中华肝脏外科手术学电子杂志, 2021, 10(04): 423-427.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

A study on the establishment of a pig model of abdominal wall incisional hernia for clinical simulation

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

A study on the establishment of a pig model of abdominal wall incisional hernia for clinical simulation